Structured Rehabilitation Program Research Articles

Structured physical therapy protocols following hip arthroscopy and their effect on patient-reported outcomes-a systematic review of the literature.

The purpose of this study was to analyze the effect of structured physical therapy protocols on patient-reported outcomes (PROs) following hip arthroscopy. A literature search was completed in October 2019 according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify articles reporting specific rehabilitation protocols following hip arthroscopy that document PROs. Studies meeting all inclusion and exclusion were reviewed and data were extracted. Six studies were included in analysis. The mean age was 34.7% and 56.6% were males. Five studies described rehabilitation protocols in phases with specific goals and progression criteria. All studies included range of motion (ROM) and weight-bearing (WB) precautions. Return to sport (RTS)/activity varied between 7 and 32 weeks. The studies used variations of 21 different PROs. Significant improvements in baseline and post-operative PROs noted across studies. Rehabilitation protocols following hip arthroscopy typically consist of 4–5 phase programs with set goals and progression criteria. Several commonalities existed between studies on WB, ROM precautions and gait normalization. However, timing and recommendations for RTS/return to work varied between studies and were dependent on the concomitant procedures performed as well as type of patient population. Clinically significant improvement in PROs from baseline noted in majority of the studies reviewed that involved a structured rehabilitation program following arthroscopic management of femoroacetabular impingement. As there is heterogeneity in patient-specific characteristics across the included studies, no determination can be made as to which protocol is most effective and further high-quality comparative studies are needed.Clinical relevanceAdopting phase-based rehabilitation protocols following arthroscopic femoroacetabular impingement treatment help achieve improved outcomes that are predictable

Interventions used by allied health professionals in sexual rehabilitation after stroke: A systematic review

ABSTRACT Background: Although sexuality can be affected post-stroke, few individuals receive sexual rehabilitation because of clinicians’ lack of knowledge regarding evidence-based interventions. Objective: To document and describe the best available evidence supporting interventions that target post-stroke rehabilitation of sexuality. Methods: This systematic review searched the databases Medline, Embase, Psycinfo, CINAHL, Web of science, PEDRO and OTSeeker up to 29 May 2020. Inclusion criteria were: published studies with a sample composed of ≥ 50% stroke clients and describing an intervention that could be applied by an allied health professional. Data was extracted according to the PRISMA guidelines by two independent reviewers. Interventions were described according to the Template for intervention description and replication checklist. Results: Among the 2446 articles reviewed, 8 met the inclusion criteria. Two randomized controlled trials (RCT) and one non-RCT showed improvement in sexual functioning and satisfaction following a 30–45-minute structured rehabilitation program. Two other RCT showed significant improvement in sexual functioning with physical therapy oriented toward 1) structured physical and verbal sexual counseling and 2) pelvic floor muscle training. Three studies showed that interdisciplinary sexual rehabilitation improved satisfaction and sexual functioning; implementation of an interview script for clinicians improved the proportion of clients who addressed sexuality from 0 to 80% in 10 months; and two-day couple retreats improved perceived intimacy between couples. Conclusions: This review highlights promising interventions that could orient future research and improve the access to sexual rehabilitation services for post-stroke, with structured sexual rehabilitation and pelvic floor muscle training being the most strongly supported.

Efficacy of early structured pulmonary rehabilitation program in pulmonary function, exercise capacity, and health-related quality of life for patients with post-tubercular sequelae: A pilot study

BackgroundResidual structural changes in the lung along with pulmonary impairment remain in a large number of patients of tuberculosis after microbiological cure. The aim of this study was to determine whether 12 weeks of a structured pulmonary rehabilitation program (PRP) administered along with antitubercular treatment improved the baseline measurement of pulmonary function, exercise capacity, and health-related quality of life (HRQOL). MethodsA pilot study with single blind randomized control design was carried out in a tertiary care chest center. Spirometry, exercise capacity by 6-minute walk distance (6MWD), and HRQOL using St George respiratory questionnaire (SGRQ) score were evaluated in 62 patients, divided into 2 groups: intervention group (IG) (n = 31) and control group (CG) (n = 31) patients at baseline and at end of 12 weeks. IG completed 12 weeks of PRP. ResultsSignificant difference in forced expiratory volume in 1st second (FEV1) (2.94 L at baseline vs 3.18 L at end of 12 weeks of PRP, diff 0.239 L, p-0.001), forced vital capacity (FVC) (3.43 L vs 3.75L, p −0.00), 6MWD (440.6 m vs 574.6 m, p = 0.00), and SGRQ score of at baseline (24.5 m vs 11.1m, p = 0.00) was seen in the IG. At end of 12 weeks, there was statistically significant difference in FEV1(L) (p = 0.01, 95% CI −0.317 to −0.046), FVC(L) (p = 0.00, 95% CI −0.359 to −0.139),6MWD(m) (p = 0.00; 95% CI −101.6 to −49.57) between CG and IG. There was no statistically significant difference in SGRQ scores between the 2 groups (p = 0.231). ConclusionPRP administered along with treatment is beneficial in reducing residual pulmonary impairment.

Managing Dyspnea in Individuals With Idiopathic Pulmonary Fibrosis.

Idiopathic pulmonary fibrosis is an unrelenting form of interstitial lung disease associated with a high symptom burden and reported low health-related quality of life. Clinicians have access to limited pharmacologic interventions to help slow the disease progression. Nonpharmacologic interventions are vital in managing dyspnea for these individuals, which is one of the most frequently reported factors that negatively impacts health-related quality of life. Common methods of symptom control include integration of pulmonary rehabilitation, supplemental oxygen, and interdisciplinary support, such as support groups, palliative care, and case conferences, into routine medical care. This literature review describes a multidisciplinary approach for managing dyspnea to improve health-related quality of life for those with idiopathic pulmonary fibrosis. Findings demonstrate that structured pulmonary rehabilitation programs, fast-track case conferences, and supplemental oxygen therapy are most effective. Further research is needed to demonstrate a clinically significant benefit of palliative care visits in the long term for these individuals.

Early initiated postoperative rehabilitation enhances quality of life in patients with operable lung cancer: Secondary outcomes from a randomized trial

IntroductionPatients with lung cancer report a lower degree of Health Related Quality of Life (HRQoL) compared with other cancer patients. HRQoL reflects how patients experience the impact of their disease and its treatment on their quality of daily living. A widely used questionnaire in lung cancer patients is the Functional Assessment of Cancer Therapy – Lung (FACT-L) questionnaire. Here we report the secondary outcomes on FACT-L data from the Postoperative Rehabilitation in Operation for Lung CAncer (PROLUCA) study, which describes the effect of early (14 days) versus late initiated (14 weeks) postoperative rehabilitation. Materials and methodsThe PROLUCA study was designed as a two-armed randomized controlled trial with an early rehabilitation group (14 days after surgery (ERG)) or a control arm with a late rehabilitation group (14 weeks after surgery (LRG)). The results for seven domain scores obtained using the FACT-L at the following time-points: baseline, 14 weeks, 26 weeks and 52 weeks after surgery are presented here. Results119 patients were randomized to the ERG and 116 to the LRG. In the ERG, HRQoL measured by both FACT-L and FACT-G (general core instrument) showed a continuous improvement up to 26 weeks after which HRQoL decreased after further 26 weeks without structured intervention. In the LRG a non-significant deterioration was detected over the first 14 weeks after surgery. After participation in the 12 weeks rehabilitation program, an increase in HRQoL was seen, without reaching the same level as the early group. ConclusionAnalyses of the seven domain scores obtained using FACT-L and FACT-G reflect the importance of starting exercise early after surgery since the ERG avoid a temporary decrease in HRQoL. It is therefore recommended to start up a structured rehabilitation program 14 days after surgery, containing high intensity interval training and strength exercise twice a week for 12 weeks.

Improvements in exercise capacity of older adults during cardiac rehabilitation.

Cardiac rehabilitation plays a vital role in secondary prevention of cardiovascular patients. Female sex and higher age, however, are associated with non-referral to cardiac rehabilitation. Improving exercise capacity during cardiac rehabilitation is essential to reduce morbidity and mortality risks. The objective of this study was to closely examine the beneficial changes in exercise capacity of older patients of both sexes during cardiac rehabilitation and to identify the most important predictors of the change in exercise capacity. A sample of 13,612 patients (mean age = 69.10 ± 11.8 years, 63.7% men, 19% > 80 years) was analysed. Data were prospectively assessed from 2012-2018 in six Swiss in-patient cardiovascular rehabilitation clinics. Improvement in exercise capacity measured with the six-minute walking test represents the outcome variable. Univariate and multivariate analyses, as well as the random forest method were used to estimate variable importance. Mean improvement in the six-minute walking test was 113.5 ± 90.5 m (men = 118.7 ± 110.0; women = 104.4 ± 93.0, Cohen's d = 0.16). The presence of heart failure, diabetes mellitus and psychiatric diagnoses was related to reduced but nonetheless clinically relevant six-minute walking test improvement. Random forest analysis suggests that baseline exercise capacity, age, time in rehabilitation and heart failure were the most important predictors for improvement in exercise capacity. Clinically relevant improvements in exercise capacity (>45 m) were also present into old age (85 years) and for both sexes. As indicated by these results, efforts need to be increased to refer eligible patients to structured rehabilitation programmes, irrespective of patients' age and sex.

Role of structured rehabilitation protocol in post surgical cases of restricted mouth opening

Long term effectiveness of surgical management of chronically restricted mouth opening in OSMF or TMJ ankylosis depends largely on postoperative physiotherapy. This in turn is dependent on patient's compliance. Use of adjunctive aids besides pharmacotherapy that reduces patients pain and improves compliance with exercise is warranted. To evaluate the role of TENS and structured rehabilitation programme in postoperative physiotherapy in OSMF and TMJ ankylosis patients. A pilot study was conducted in which 6 patients of restricted mouth opening were put on a structured rehabilitation protocol in which TENS, heat and cold therapy with structured mouth opening exercise regimes. Interincisal opening, VAS score and a subjective assessment of post surgical discomfort was evaluated. Results revealed an improved compliance and cooperation by patients. Pain on VAS scale also reduced from mean of 7.8 on day 1 to 3.6 on day 5 in this group. The mean discomfort on day 3 was reported as mild to moderate. An early attainment of passive mouth opening closest to intraoperative mouth opening was also reported on day 5 which is usually not achievable without any physiotherapy intervention.

Evaluation of the effectiveness of rehabilitation of people diagnosed with schizophrenia using clinical tools, psychological tests, QEEG, and the brain-derived neurotrophic factor (BDNF).

The aim of the study was to evaluate the level of cognitive and social functioning in two groups of schizophrenia patients using clinical tools, psychological tests, QEEG, and changes in the brain-derived neurotrophic factor (BDNF) activity in subjects' serum. Randomly selected men diagnosed with schizophrenia were enrolled in the study and divided into two groups. Gr. 1 was formed by patients who did not undergo a structured rehabilitation program, while Gr. 2 was formed by patients undergoing standard rehabilitation, as provided in theprogramof the Psychiatric Rehabilitation Unit. Both groups underwent a comparative analysis of demographic parameters and based on: PANSS, AIS, GSES, and BCIS, psychological tests CTT-1, CTT-2, d2, QEEG, and changes in blood BDNF levels. To assess the effect of rehabilitation, the results obtained in both groups were compared after 12 weeks and their analysis was performed in accordance with assumptions for the experimental project. The study presents research hypotheses and pre-test and post-test comparisons of the groups, on the basis of selected research tools. The data obtained in measurement 1 indicate that both groups did not differ significantly in terms of: age, education, place of residence, treatment at outpatient facilities, medicines taken, and suicide attempts. Differences concerned: marital status, children, number of hospitalizations, and employment status. Furthermore, no significant differences were found for the studied groups concerning: serum levels of the brain-derived neurotrophic factor, values obtained on the PANSS, AIS, and GSES, and alpha/theta, theta/beta and theta/SMR ratios. The analyses performed in measurement 2 indicate that structured rehabilitation influences reduce negative symptoms, cause an increase in BDNF levels, cause an improvement in cognitive and social functioning and positively influence the perception speed and accuracy. The positive effect of structured rehabilitation influences allows to say that rehabilitation represents a necessary part of the comprehensive psychiatric treatment and should already be implemented during the first episode of the illness.

Surface Electromyographic Biofeedback as a Rehabilitation Tool for Patients with Global Brachial Plexus Injury Receiving Bionic Reconstruction.

In patients with global brachial plexus injury and lack of biological treatment alternatives, bionic reconstruction, including the elective amputation of the functionless hand and its replacement with a prosthesis, has recently been described. Optimal prosthetic function depends on a structured rehabilitation protocol, as residual muscle activity in a patient's arm is later translated into prosthetic function. Surface electromyographic (sEMG) biofeedback has been used during rehabilitation after stroke, but has so far not been used in patients with complex peripheral nerve injuries. Here, we present our rehabilitation protocol implemented in patients with global brachial plexus injuries suitable for bionic reconstruction, starting from identification of sEMG signals to final prosthetic training. This structured rehabilitation program facilitates motor relearning, which may be a cognitively debilitating process after complex nerve root avulsion injuries, aberrant re-innervation and extra-anatomical reconstruction (as is the case with nerve transfer surgery). The rehabilitation protocol using sEMG biofeedback aids in the establishment of new motor patterns as patients are being made aware of the advancing re-innervation process of target muscles. Additionally, faint signals may also be trained and improved using sEMG biofeedback, rendering a clinically "useless"muscle (exhibiting muscle strength M1 on the British Medical Research Council [BMRC] scale) eligible for dexterous prosthetic hand control. Furthermore, functional outcome scores after successful bionic reconstruction are presented in this article.

Motor Capabilities of Lower Limb Amputated Patients and Its Relation to Body Image and Depression

Background: Lower limb amputation is a great event in the life of individual’s which having an counteractive effect on overall physical, psychological and social functioning of an individual so the study aim is to measure relation of motor capabilities of lower limb amputated patients on body image and depression level. Methods: Design: The descriptive correctional research design was utilized to achieve the aim of the study. Sample: A convenient sample of sixty four participant consisted of male and female adult amputee patients. Setting : This study was conducted in Rheumatology and Rehabilitation Department at Minia University Hospital. Tools of data collection: Three scales and one tool were utilized; Bio socio-demographic characteristic and structured interview, Locomotor Capabilities Index, Amputee Body Image Scale and Beck Depression Inventory (BDI) scale. Results: 73.5% of the amputated patients have low locomotor capabilities while 93.7% of the study sample has a low body image and 31.2% of the study sample suffers from moderate depression after 6 month from amputation and high positive significant correlation between locomotor capabilities and body image, while that there was a high negative significant correlation between locomotor capabilities and depression level among the imputed patients. Conclusions: The recent amputee patients that are have lower limb prosthesis suffer from low locomotor capabilities and theses have negative impact on their body image and depression level. Recommendation: A well planned structured rehabilitation program should be done to the specific needs of people with limb amputation in order to be able to find out its impact on their functional abilities, body image and depression level. Keywords: Amputation, locomotors capabilities, Body image, Depression. DOI : 10.7176/JHMN/64-03 Publication date :July 31 st 2019

Pediatric Cardiac Rehabilitation: a Review

In addition to concerns with physical health and activity levels, children with cardiac conditions can be at risk of neurodevelopmental and socioemotional maladjustment. Children with congenital heart defects requiring surgery early in life are at risk of developmental delays and cognitive impairments, and both children with congenital heart defects and those with cardiomyopathies are at risk of socioemotional concerns. As a result, there is an increasing focus on rehabilitation efforts for these patients, in order to improve both their physical well-being and their adjustment outcomes. However, there are no established standards for rehabilitation programs applicable across children with cardiac conditions, in stark contrast to guidelines for adult patients. The purpose of the present review is to summarize recent studies on pediatric cardiac rehabilitation and describe the structure of our own program, in order to aid with the delineation of future guidelines. Twenty programs for pediatric cardiac rehabilitation were identified and reviewed. We review inpatient, outpatient, and home-based programs, most of which include two to three sessions of exercise training per week for 12 weeks with a focus on improving exercise capacity. We also review emerging cognitive rehabilitation for children with cardiac disorders and discuss a newly developed program at our own institution. A review of past findings, along with recent efforts at our institution, suggests that a structured cardiac rehabilitation program can benefit children by increasing exercise response and physical activity as well as improving developmental, cognitive, and psychosocial outcomes.

Rehabilitation and nutrition protocols for optimising return to play from traditional ACL reconstruction in elite rugby union players: A case study

ABSTRACTCurrent nutrition and exercise focus during rehabilitation periods has been on reducing muscle atrophy associated with immobilisation. This case report outlines a best practice anterior cruciate ligament (ACL) rehabilitation programme undertaken by two professional rugby athletes, with the addition of an evidence-based supplementation (gelatine and vitamin C) and exercise protocol focused on collagenous tissue. Both players ruptured their left ACL and were repaired with a traditional hamstring graft. Players undertook a structured rehabilitation programme for 34 weeks before being clinically assessed ready to play. Players saw minimal changes in body composition in the early rehabilitation period (P1 – 0.8 kg; P2 – 0.4 kg). Leg lean mass reduced in both legs of Player 1 (Injured – 0.8 kg, Non-injured – 0.6 kg) at 17 weeks, with Player 2 only experiencing a loss of 0.3 kg of lean tissue in the injured leg. Both players returned to baseline body compositions after 24 weeks. Leg strength returned to a maximum at 24 and 15 weeks, respectively, with knee function returning to baseline by 30 weeks. This case report provides evidence that nutrition and rehabilitation programmes targeted at minimising the effects of disuse in both muscle and connective tissue may assist return to play after ACL injury.

PLEOMORPHIC SARCOMA IN A PILOT

ABSTRACT Sarcomas are rare malignant soft tissue tumours. This case report outlines a 45 year old pilot, presenting with a non-tender mass in his left medial thigh, subsequently diagnosed with a pleomorphic sarcoma. His management consisted of radiotherapy and surgical removal. Grading was considered FNCLCC grade 3 and there were no metastases. Surgery was followed by a structured rehabilitation program. The paper discusses aeromedical considerations for return to flying duties, regarding the natural history of the condition and recurrence risk as well as the operational mitigations to flight incapacitation risk.

Structured Goal Planning and Supportive Telephone Follow-up in Rheumatology Care: Results From a Pragmatic, Stepped-Wedge, Cluster-Randomized Trial.

To evaluate patient-reported health effects of an add-on structured goal-planning and supportive telephone follow-up rehabilitation program compared with traditional rehabilitation programs in patients with rheumatic diseases. In this pragmatic stepped-wedge, cluster-randomized, controlled trial, 389 patients with rheumatic diseases recruited from 6 rehabilitation centers received either traditional rehabilitation or traditional rehabilitation extended with an add-on program tailored to individual needs. The add-on program comprised a self-management booklet, motivational interviewing in structured individualized goal planning, and 4 supportive follow-up phone calls after discharge. Data were collected by questionnaires on admission and discharge from rehabilitation stay, and at 6 months and 12 months after discharge. The primary outcome was health-related quality of life (HRQoL) measured by the Patient Generated Index (range 0-100, where 0 = low). Secondary outcomes included patient-reported health status, self-efficacy, pain, fatigue, global disease activity, and motivation for change. The main statistical analysis was a linear repeated measures mixed model performed on the intent-to-treat population using all available data. A significant treatment effect of the add-on intervention on HRQoL was found on discharge (mean difference 3.32 [95% confidence interval 0.27, 6.37]; P = 0.03). No significant between-group differences were found after 6 or 12 months. Both groups showed positive changes in HRQoL following rehabilitation, which gradually declined, although the values remained at higher levels after 6 and 12 months compared with baseline values. The add-on program enhanced the short-term effect of rehabilitation with respect to patient-specific HRQoL, but it did not prolong the effect as intended.

Multidirectional Instability of the Shoulder: Treatment Options and Considerations.

Multidirectional instability (MDI) is a debilitating condition that involves chronic subluxation or dislocation of the shoulder in >1 direction. Numerous proposed mechanisms of MDI exist, which occurs in the setting of redundant capsular tissue. Symptoms can range from recurrent dislocations or subluxations to vague aching pain that disrupts activities of daily living. Magnetic resonance imaging is often performed during evaluation of this condition, although magnetic resonance arthrography may provide more detailed images of the patulous capsule. In the absence of a well-defined traumatic cause, such as a labral tear, initial treatment for MDI is a structured rehabilitation program with exercises aimed at strengthening the rotator cuff and periscapular muscles to improve scapular kinematics. Patients with recalcitrant symptoms may benefit from surgical stabilization, including open capsular shift or arthroscopic capsular plication, aimed at decreasing capsular volume and improving stability.

Doentes Após Seis Meses de Acidente Vascular Cerebral: Nível de Incapacidade Funcional

Enquadramento: o Acidente Vascular Cerebral (AVC) é uma patologia com um elevado impacto na funcionalidade do indivíduo. Objetivos: avaliar os níveis de funcionalidade no doente com AVC seis meses após a sua ocorrência; analisar a relação entre níveis de funcionalidade do doente e as variáveis sociodemográficas, clínicas e familiares. Metodologia: estudo descritivo, correlaciona!. A amostra é não probabilística por conveniência, constituída por 72 pessoas, que tiveram AVC, após seis meses da sua ocorrência. Para a colheita de dados utilizou-se um questionário constituído por uma parte de caracterização sociodemográfica, o Índice de Barthel e a Escala de Apgar Familiar. Resultados: a idade, o género, a coabitação e o rendimento familiar, demonstraram ter uma relação muito significativa com a capacidade funcional, em algumas dimensões. Os hábitos alcoólicos, os hábitos tabágicos, a diabetes, o stresse e a hipertensão arterial interferem igualmente nessa capacidade, bem como na área obstruída do cérebro. Conclusão: os resultados apontam que os fatores de risco estão associados a uma fraca capacidade funcional. A implementação de medidas preventivas, a promoção de bons hábitos de saúde e o início precoce de programas estruturados de reabilitação são fundamentais na minimização do impacto negativo do AVC na qualidade de vida.

The Utilization of Formal Physical Therapy After Shoulder Arthroplasty.

It is widely believed that structured rehabilitation programs by professional therapists help guide patients through the various recovery periods after shoulder arthroplasty, speeding up their recovery and improving their final functional gains. However, to our knowledge, there are no studies providing information about the current state of physical rehabilitation use after shoulder arthroplasty. To describe the variation in physical rehabilitation utilization after total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA), and to identify differences in utilization based on type of insurance (private versus public), sex, age, and region of the country. This epidemiological retrospective database study utilized a commercially available database, PearlDiver, with longitudinal patient tracking linking all patients' Current Procedural Terminology and International Classification of Diseases-Ninth Revision codes to their specific records to analyze patterns of physical rehabilitation usage after TSA and RSA in the United States. Two main patient populations were analyzed within the PearlDiver database, the Humana private insurance population and the Medicare insurance population. The period analyzed was 2010 to 2015. There was significantly higher utilization of physical rehabilitation in the Humana population when compared to the Medicare population (P<.001, Cramer's V = 0.270). In the Humana population, 36% of patients had 5 or fewer physical rehabilitation visits in the 6 months following their operation, while in the Medicare population, 56% of patients had 5 or fewer physical rehabilitation visits in the same period. Those with TSA had a higher utilization rate than those with RSA in the Humana (P<.001, V = 0.104; TSA, 31% had 5 or fewer physical rehabilitation visits; RSA, 40% had 5 or fewer physical rehabilitation visits within 6 months) and Medicare populations (P<.001, V = 0.135; TSA, 51% had 5 or fewer physical rehabilitation visits; RSA, 61% had 5 or fewer physical rehabilitation visits within 6 months). Postoperative utilization of physical rehabilitation after anatomic TSA and RSA is markedly higher in privately insured patients than in patients with Medicare, regardless of age, sex, diagnosis, or region of country. These findings have important implications, from the individual patient's experience and outcomes to system-wide resource utilization. Economic and decision analyses, level 4. J Orthop Sports Phys Ther 2018;48(11):856-863. Epub 8 May 2018. doi:10.2519/jospt.2018.8176.

ACL Rehabilitation Progression: Where Are We Now?

With the increase of publications available to the rehabilitation specialist, there is a need to identify a progression to safely progress the patient through their post-operative ACL reconstruction rehabilitation program. Rehabilitation after ACL reconstruction should follow an evidence-based functional progression with graded increase in difficulty in activities. Clinicians should be discouraged not to use strict time frames and protocols when treating patients following ACL reconstruction. Rather, guidelines should be followed that allow the rehabilitation specialists to progress the patient as improvements in strength, edema, proprioception, pain, and range of motion are demonstrated. Prior to returning to sport, specific objective quantitative and qualitative criteria should be met. The time from surgery should not be the only consideration. The rehabilitation specialist needs to take into account tissue healing, any concomitant procedures, patellofemoral joint forces, and the goals of the patient in crafting a structured rehabilitation program. Achieving symmetrical full knee extension, decreasing knee joint effusion, and quadriceps activation early in the rehabilitation process set the stage for a safe progression. Weight bearing is begun immediately following surgery to promote knee extension and hinder quadriceps inhibition. As the patient progresses through their rehabilitative course, the rehabilitation specialist should continually challenge the patient as is appropriate based upon their goals, their levels of strength, amount of healing, and the performance of the given task.

The Impact of Text Messaging on Medication Adherence and Exercise Among Postmyocardial Infarction Patients: Randomized Controlled Pilot Trial.

BackgroundAdherence to evidence-based therapies such as medications and exercise remains poor among patients after a myocardial infarction (MI). Text message reminders have been shown to improve rates of adherence to medication and exercise, but the existing studies have been of short duration.ObjectiveTwo single-center randomized controlled pilot trials were conducted to evaluate the impact of text message reminders over 12 months on adherence to cardiac medications and exercise among patients receiving cardiac rehabilitation after hospitalization for MI.MethodsIn the medication adherence trial, 34 patients were randomized to receive usual care alone or usual care plus daily text message reminders delivered at the time of day at which medications were to be taken. In the exercise adherence trial, 50 patients were randomized to receive usual care alone or usual care plus 4 daily text messages reminding them to exercise as directed.ResultsThe text message reminders led to a mean 14.2 percentage point improvement in self-reported medication adherence over usual care (P<.001, 95% CI 7-21). In the exercise trial, text message reminders resulted in an additional 4.2 days (P=.001, 95% CI 1.9-6.4) and 4.0 hours (P<.001, 95% CI 2.4-5.6) of exercise per month over usual care and a nonsignificant increase of 1.2 metabolic equivalents (METS; P=.06) in exercise capacity as assessed by a BRUCE protocol at 12 months.ConclusionsText message reminders significantly increased adherence to medication and exercise among post-MI patients receiving care in a structured cardiac rehabilitation program. This technology represents a simple and scalable method to ensure consistent use of evidence-based cardiovascular therapies.Trial RegistrationClinicaltrials.gov NCT02783287; https://clinicaltrials.gov/ct2/show/NCT02783287 (Archived by WebCite at http://www.webcitation.org/6sBnvNb05)

Needs of Caregivers of People with Mental Illness- Rehabilitation Perspective

Introduction: Chronic nature of major mental illnesses can have a devastating impact on persons with mental illness (PWMI) and the caregivers. Rehabilitation is a long lasting phase of psychiatric treatment. The study focus on rehabilitation needs of the caregivers of PWMI attending psychiatric outpatient department at a tertiary care hospital. Methods: A cross sectional study was carried out at All India Institute of Medical Sciences (AIIMS) Rishikesh, Uttarakhand. A purposive sample of 100 caregivers of persons with mental illness was interviewed to assess rehabilitation needs. Information on socio-demographic profile and rehabilitation needs was ascertained by using a self-administered pre-tested questionnaire. Appropriate descriptive statistics was applied to formulate the results. Results: Findings revealed that medical needs (10.04±2.61), self-care (10.11±2.48) and stress management needs (10.20±4.72) were more compared to others needs. Few caregivers reported the incidences of facing stigma at workplace and society (9.74±2.49) because of their ward’s mental illness. Further, it also revealed that needs related to peer/community support, development of right attitude towards the care of the PWMI and management for worries and apprehension due to the condition of PWMI are quite frequently reported rehabilitation needs by the caregivers. Conclusion: A successful rehabilitation services always should be need based. Types and severity of disability of the PWMI will also play an important role in designing a structured rehabilitation programme. This study warrants further study based on large sample size to design successful rehabilitation services for persons with mental illness. Keywords- Mental illness, rehabilitation, needs, caregiver